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Tendon injuries in orthopedic surgery and sports medicine are escalating; hence there is great interest in improving tendon repair. The integrity of tendon repair depends in part on a combination of suture material, suture size and knot configuration. Recent studies have indicated the failure of surgical knots as a failure mode during surgical repair. Further, there is still no consensus on the ideal (best/safest) surgical knot techniques. Also, this failure mode is related to stress concentrations, which cannot be easily established with traditional tensile testing. Most researchers have focused on the measurement and comparison of the gross structural response of non-knotted and knotted suture, without direct investigation of the governing mechanics. Therefore, the purpose of this study is to develop a finite element approach to analyze the mechanical behavior of surgical sutures. Also, this analysis is necessary to differentiate the responses of several knot configurations and be validated against experiments. To achieve this purpose, experiments and finite element models are performed to analyze the mechanical behavior of two types of sutures: monofilament and multifilament. Fixtures are experimentally designed to test (non-knotted/ knotted) sutures under tensile load until failure. The knotted sutures are included single, two and three throws-knots. Non-knotted suture and a single throw-knot are modeled and analyzed. Finite element model and experimental results are presented using as-manufactured multifilament surgical suture: core and jacket. The experimental results indicate suture mechanical behavior is influenced by increasing number of throws; this effect is highly dependent on the suture constituents. The presence of a knot reduces failure load; thus rupture occurs consistently at the knot region. The finite element models predict maximum stress regions; the regions are correlated with experimental failures. This study also investigates the shear lag phenomenon of partially failed multifilament suture by analyzing the stress distribution under static and cyclic loading. Furthermore, a valid design for testing the knotless anchors is reported.
This well-illustrated book presents the state of the art in suture materials and provides clear, step-by-step guidance on how to tie the most frequently used knots. The opening section addresses terminological issues and describes how the biological and mechanical properties of suture materials may impact on healing potential. The basics of knot biomechanics are explained, highlighting the risk of failure of knots and sutures if their capacities are exceeded. Subsequent sections give precise instructions on the tying techniques for the various open and arthroscopic knots, including the square knot, the surgeon’s knot, half hitches, and sliding and non-sliding knots. The special instruments available to facilitate the tying of arthroscopic knots are thoroughly discussed, equipping the surgeon with the knowledge required to ensure optimal handling of the soft tissues and manipulation of sutures in arthroscopic surgery. A literature review on suture materials and arthroscopic knots completes the coverage. This book is published in cooperation with ESSKA. It will be a valuable instruction manual for surgeons in training and will supply more experienced surgeons with an excellent update that will further enhance their practice.
Keywords: medical textile, x-ray, image analysis, dsc, suture, barbs.
This book introduces the surgical suture techniques in orthopaedics. These techniques have been recognized as a crucial part for wound care and surgery-related prognosis. Training of fellows on suture techniques is of great importance. This book provides a standard tutorial on how to be proficient in surgical suture performance. The history and basic concepts are introduced. Important issues when considering suture methods, including site infections, suturing materials, room setups, cosmetics and drainage are also discussed fully. Different types of suture techniques applying to orthopaedic surgeries are presented with illustrations. The author strives to implement the principle that orthopaedic theory should be connected with clinical practice, highlight the application of theoretical knowledge, strengthen the pertinence and practicality of suture techniques, and reflect domestic and international development trends to the greatest extend.
Virtually every wound, whether surgical or traumatic, needs to be closed to promote wound healing and prevent infection. Increasingly sophisticated and effective materials for the crucial surgical treatment of wound closure are being developed continuously. Keep up with the most recent research progress and future trends in this complex and rapidly changing field with Wound Closure Biomaterial and Devices. This state-of-the-art book provides detailed information and critical discussions on: ï Sutures and other wound closure devices, including absorbable sutures and their biodegradation properties ï The chemistry, physics, mechanics, biology, and biomaterials science of suture materials ï Tissue adhesive, ligating clips, and staplers ï The biomechanics and pathology of wound healing ï Future trends and new emerging materials in the treatment of wound closure
Detailed knowledge of tissue mechanical properties is widely required by medical applications, such as disease diagnostics, surgery operation, simulation, planning, and training. A new two degrees of freedom portable device, called Tissue Resonator Indenter Device (TRID), has been developed for measurement of regional viscoelastic properties of soft tissues at the Bio-instrument and Biomechanics Lab of the University of Toronto. As a device for clinical application, the accuracy and reliability of TRID is crucial. This thesis thus investigates the tissue samples' mechanical properties through finite element analysis method after reviewing the experimental results of the same tissue samples using TRID. The accuracy of TRID is verified through comparing its experimental results with finite element simulation results of tissue mechanical properties. This thesis also investigates the reliability of TRID through experimental study of its indenter misalignment effect on the measurement results of tissue static stiffness, dynamic stiffness, and damping respectively.
Computer-aided minimally invasive surgery (MIS) has progressed significantly in the last decade and it has great potential in surgical planning and operations. To limit the damage to nearby healthy tissue, accurate modeling is required of the mechanical behavior of a target soft tissue subject to surgical manipulations. Therefore, the study of soft tissue deformations is important for computer-aided (MIS) in surgical planning and operation, or in developing surgical simulation tools or systems. The image acquisition facilities are also important for prediction accuracy. This dissertation addresses partial differential and integral equations (PDIE) based biomechanical modeling of soft tissue deformations incorporating the specific material properties to characterize the soft tissue responses for certain human interface behaviors. To achieve accurate simulation of real tissue deformations, several biomechanical finite element (FE) models are proposed to characterize liver tissue. The contribution of this work is in theoretical and practical aspects of tissue modeling. High resolution imaging techniques of Micro Computed Tomography (Micro-CT) and Cone Beam Computed Tomography (CBCT) imaging are first proposed to study soft tissue deformation in this dissertation. These high resolution imaging techniques can detect the tissue deformation details in the contact region between the tissue and the probe for small force loads which would be applied to a surgical probe used. Traditional imaging techniques in clinics can only achieve low image resolutions. Very small force loads seen in these procedures can only yield tissue deformation on the few millimeters to sub-millimeter scale. Small variations are hardly to detect. Furthermore, if a model is validated using high resolution images, it implies that the model is true in using the same model for low resolution imaging facilities. The reverse cannot be true since the small variations at the sub-millimeter level cannot be detected. In this dissertation, liver tissue deformations, surface morphological changes, and volume variations are explored and compared from simulations and experiments. The contributions of the dissertation are as follows. For liver tissue, for small force loads (5 grams to tens of grams), the linear elastic model and the neo-Hooke's hyperelastic model are applied and shown to yield some discrepancies among them in simulations and discrepancies between simulations and experiments. The proposed finite element models are verified for liver tissue. A general FE modeling validation system is proposed to verify the applicability of FE models to the soft tissue deformation study. The validation of some FE models is performed visually and quantitatively in several ways in comparison with the actual experimental results. Comparisons among these models are also performed to show their advantages and disadvantages. The method or verification system can be applied for other soft tissues for the finite element analysis of the soft tissue deformation. For brain tissue, an elasticity based model was proposed previously employing local elasticity and Poisson's ratio. It is validated by intraoperative images to show more accurate prediction of brain deformation than the linear elastic model. FE analysis of brain ventricle shape changes was also performed to capture the dynamic variation of the ventricles in author's other works. There, for the safety reasons, the images for brain deformation modeling were from Magnetic Resonance Imaging (MRI) scanning which have been used for brain scanning. The measurement process of material properties involves the tissue desiccation, machine limits, human operation errors, and time factors. The acquired material parameters from measurement devices may have some difference from the tissue used in real state of experiments. Therefore, an experimental and simulation based method to inversely evaluate the material parameters is proposed and compared with the material parameters measured by devices. As known, the finite element method (FEM) is a comprehensive and accurate method used to solve the PDIE characterizing the soft tissue deformation in the three dimensional tissue domain, but the computational task is very large in implementation. To achieve near real time simulation and still a close solution of soft tissue deformation, region-of-interest (ROI) based sub-modeling is proposed and the accuracy of the simulated deformations are explored over concentric regions of interest. Such a ROI based FE modeling is compared to the FE modeling over the whole tissue and its efficiency is shown and as well as its influence in practical applications such as endoscopic surgical simulation.